Current Best Practice in Hepatitis B Management & Understanding Long-Term Prospects for Cure

The hepatitis B virus (HBV) is a major cause of cirrhosis and hepatocellular carcinoma worldwide. Despite an effective vaccine the prevalence of chronic infection remains high. Current therapy is effective at achieving on-treatment but not off-treatment viral suppression. Loss of hepatitis B surface antigen (HBsAg), the best surrogate marker of off-treatment viral suppression, is associated with improved clinical outcomes. Unfortunately, this endpoint is rarely achieved with current therapy because of their lack of effect on covalently closed circular DNA, the template of viral transcription and genome replication.

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Ottobre 2022

HBV antigens quantity: duration and effect on functional cure

HBV is a DNA virus that coevolved with humans.1 Different from many other viruses that are detected only after amplification of their genetic material, HBV is characterised by the production of a progeny of infectious virions, but also of high concentrations (5–10 μg/mL) of viral proteins. These proteins are ‘byproducts’ of the synthesis of the proteins coded by HBV core and HBV pre-S1, pre-S2 and S genes, the building blocks of the nucleocapsid (the internal part of the virus containing HBV–DNA) and of the HBV envelope. The proteins derived from the nucleocapsid gene and defined as HBcrAg are composed of truncated or immature forms of the nucleocapsid protein: the HBeAg (defined also as p17, a fully secreted form of truncated nucleoprotein), p22 (a longer version of p17) and HBcAg (incomplete core particles, a ‘naked’ HBV).2 The pre-S1, pre-S2 and S gene products are instead envelope components…

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Ottobre 2022

An ounce of prevention is worth a pound of cure–the arts as a vehicle for knowledge translation and exchange (KTE) in public health during a pandemic: a realist-informed developmental evaluation research protocol

Introduction
The COVID-19 crisis has led to the adoption of strict and coercive preventive measures. The implementation of these measures has generated negative impacts for many communities. The situation is especially worrisome for Indigenous communities in Peru. Therefore, it is necessary to recognise the contribution of the experiential knowledge of Indigenous communities and to implement innovative approaches. The use of art can be a promising avenue for working in partnership with Indigenous communities.
The goal of this research is to (1) develop an intervention promoting barrier measures and vaccination to limit the transmission of COVID-19 among Indigenous communities using an arts-based and community-based knowledge translation and exchange (ACKTE) model; and (2) understand the contextual elements and mechanisms associated with the process of developing a preventive intervention using the ACKTE model.

Methodology and analysis
This research will take place in Indigenous communities in Peru and will be based on a developmental evaluation guided by the principles of realist evaluation. Members of two Indigenous communities, local authorities, health professionals and artists will participate in the intervention development process as well as in the developmental evaluation. For data collection, we will conduct modified talking circles and semistructured individual interviews with stakeholders as well as an analysis of documents and artistic works produced.

Ethics and dissemination of results
This research received the approval of the Université du Québec à Rimouski’s research ethics board. In addition to scientific articles, the results of this research will be disseminated through videos and during an artistic performance.

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Settembre 2022

Understanding the implementation strategy of a secondary care tobacco addiction treatment pathway (the CURE project) in England: a strategic behavioural analysis

Objectives
The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project implemented an evidence-based intervention that offers a combination of pharmacotherapy and behavioural support to tobacco-dependent inpatients. Understanding key characteristics of CURE’s implementation strategy, and identifying areas for improvement, is important to support the roll-out of nationwide tobacco dependence services. This study aimed to (1) specify key characteristics of CURE’s exiting implementation strategy and (2) develop theoretical-informed and stakeholder-informed recommendations to optimise wider roll-out.

Design and methods
Data were collected via document review and secondary analysis of interviews with 10 healthcare professionals of a UK hospital. Intervention content was specified through behaviour change techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A logic model was developed to specify CURE’s implementation strategy and its mechanisms of impact. We explored the extent to which BCTs and intervention functions addressed the key theoretical domains influencing implementation using prespecified matrices. The development of recommendations was conducted over a two-round Delphi exercise.

Results
We identified six key theoretical domains of influences: ‘environmental context and resources’, ‘goals’, ‘social professional role and identity’, ‘social influences’, ‘reinforcement’ and ‘skills’. The behavioural analysis identified 26 BCTs, 4 intervention functions and 4 policy categories present within the implementation strategy. The implementation strategy included half the relevant intervention functions and BCTs to target theoretical domains influencing CURE implementation, with many BCTs focusing on shaping knowledge. Recommendations to optimise content were developed following stakeholder engagement.

Conclusions
CURE offers a strong foundation from which a tobacco dependence treatment model can be developed in England. The exiting strategy could be strengthened via the inclusion of more theoretically congruent BCTs, particularly relating to ‘environmental context and resources’. The recommendations provide routes to optimisation that are both theoretically grounded and stakeholder informed. Future research should assess the feasibility/acceptability of these recommendations in the wider secondary-care context.

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Giugno 2022